Background the effect of alcohol intoxication on the outcomes of traumatic brain injury (TBI) is debatable although recent data are in favour of its protective role. We aimed to evaluate the impact of alcohol status on the hospital outcomes in patients with TBI of different mechanisms of injury (MOI).

Methods A retrospective observational analysis was conducted for all TBI patients admitted in a level 1 trauma centre between 2010 and 2014. Patients were divided into 2 groups according to the serum alcohol (negative alcohol; NATBI vs positive alcohol TBI; PATBI). Patients demographics, injury severity score (ISS), head injury severity (AIS), type of TBI lesions and hospital outcomes were analysed and compared in the 2 groups in general and in relation to the MOI in terms of motor vehicle crashes (MVC),pedestrians injury, and fall from height.

Results Over the study period, 805 patients (93% males) were admitted with TBI with a median age of 28 (1–86) years. PATBI was found in 14% of cases. Mean ISS (P = 0.10), and hospital pneumonia (p = 0.07), sepsis (p = 0.88) and mortality (p = 0.08) were fewer in PATBI in comparison to NATBI patients. In-hospital acute respiratory syndrome (ARDS) was higher in PATBI (p = 0.31). Head AIS was greater in NATBI patients (p = 0.04). PATBI was greater among pedestrians (22%) followed by fall (13%) and MVC (12%). Among pedestrians, diffuse axonal injury, subarachnoid haemorrhage, skull fractures and mortality were significantly lesser in PATBI. Alcoholic pedestrians had higher proportion of polytrauma (p = 0.02). In fall-related injury, alcoholic patients had lower proportion of intubation (p = 0.02) and brain oedema (p = 0.05). MVC-related PATBI patients had more intrahemisheric haemorrhage but less skull fracture (p = 0.02) and epidural haemorrhage (0 = 0.03).

Conclusions the proportion of positive alcohol among TBI is high; however, it shows better hospital survival. Screening of alcohol among TBI gives important clues in terms of the type of TBI lesions in relation to different mechanisms of injury. Early identification of alcoholic status and its early management could be reflected in better outcome among this set of population. This analysis is limited with the lack of long-term follow-up and patients disabilities.